Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg

Background/aim: This study aimed to investigate the clinical features, modality, complications, and effecting factors on the survival of children weighing up to 10 kg who received continuous renal replacement therapy (CRRT). Materials and methods: This study was a retrospective observational study conducted in five pediatric intensive care units in tertiary hospitals in Turkey between January 2015 and December 2019. Results: One hundred and forty-one children who underwent CRRT were enrolled in the study. The median age was 6 (range, 2–12) months, and 74 (52.5%) were male. The median weight of the patients was 6 (range, 4–8.35) kg and 52 (36.9%) weighed less than 5 kg. The most common indication for CRRT was fluid overload in 75 (53.2%) patients, and sepsis together with multiorgan failure in 62 (44%). The overall mortality was 48.2%. Conclusion: Despite its complexity, CRRT in children weighing less than 10 kg is a beneficial, lifesaving extracorporeal treatment modality.

Anahtar Kelime: Continuous renal replacement therapy children pediatric intensive care unit

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Sutherland SM, Alexander SR. Continuous renal replacement therapy in children. Pediatric Nephrology 2012; 27 (11):2007- 2016. https://doi: 10.1007/s00467-011-2080-x
2. Sık G, Demirbuga A, Günhar S, Nisli K, Citak A. Clinical Features and Indications Associated with Mortality in Continuous Renal Replacement Therapy for Pediatric Patients. Indian Journal of Pediatrics 2019; 86 (4): 360-364. https://doi: 10.1007/s12098-019-02868-w
3. Raymakers-Janssen P, Lilien M, van Kessel IA, Veldhoen ES, Wösten-van Asperen RM, van Gestel JPJ. Citrate versus heparin anticoagulation in continuous renal replacement therapy in small children. Pediatric Nephrology 2017; 32 (10): 1971-1978. https:// doi: 10.1007/s00467-017-3694-4
4. Kramer P, Wigger W, Rieger J, Matthaei D, Scheler F. Arteriovenous haemofiltration: a new and simple method for treatment of over-hydrated patients resistant to diuretics. Klin Wochenschrift 1977; 55 (22): 1121-1122. https://doi: 10.1007/ bf01477940
5. Leone MR, Jenkins RD, Golper TA, Alexander SR. Early experience with continuous arteriovenous hemofiltration in critically ill pediatric patients. Critical Care Medicine 1986; 14 (12): 1058- 1063. https://doi: 10.1097/00003246-198612000-00014
6. Noh ES, Kim HH, Kim HS, Han YS, Yang M et al. Continuous Renal Replacement Therapy in Preterm Infants. Yonsei Medical Journal 2019; 60 (10): 984-991. https://doi: 10.3349/ ymj.2019.60.10.984
7. Diane Mok TY, Tseng MH, Chiang MC, Lin JL, Chu SM et al. Renal replacement therapy in the neonatal intensive care unit. Pediatric Neonatology 2018; 59 (5): 474-480. https://doi: 10.1016/j.pedneo.2017.11.015
8. Askenazi DJ, Goldstein SL, Koralkar R, Fortenberry J, Baum M et al. Continuous renal replacement therapy for children ≤10 kg: a report from the prospective pediatric continuous renal replacement therapy registry. Journal of Pediatrics 2013; 162 (3): 587-592. https://doi: 10.1016/j.jpeds.2012.08.044
9. Kornecki A, Tauman R, Lubetzky R, Sivan Y. Continuous renal replacement therapy for non-renal indications: experience in children. Israel Medicine Association Journal 2002; 4 (5): 345- 348
10. Symons JM, Brophy PD, Gregory MJ, McAfee N, Somers MJ et al. Continuous renal replacement therapy in children up to 10 kg. American Journal of Kidney Diseases 2003; 41 (5): 984-989. https://doi: 10.1016/s0272-6386(03)00195-1
11. Selewski DT, Cornell TT, Lombel RM, Blatt NB, Han YY et al. Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy. Intensive Care Medicine 2011; 37 (7): 1166-1173. https://doi: 10.1007/s00134-011-2231-3
12. Bresolin N, Silva C, Halllal A, Toporovski J, Fernandes V et al. Prognosis for children with acute kidney injury in the intensive care unit. Pediatric Nephrology 2009; 24 (3): 537-544. https:// doi: 10.1007/s00467-008-1054-0
13. Kaempfen S, Dutta-Kukreja P, Mok Q. Continuous Venovenous Hemofiltration in Children Less Than or Equal to 10 kg: A Single-Center Experience. Pediatric Critical Care Medicine 2017;18 (2): 70-76. https://doi: 10.1097/pcc.0000000000001030
14. de Galasso L, Picca S, Guzzo I. Dialysis modalities for the management of pediatric acute kidney injury. Pediatric Nephrology 2020; 35 (5): 753-765. https:// doi: 10.1007/s00467- 019-04213-x
15. Yetimakman AF, Tanyildiz M, Kesici S, Kockuzu E, Bayrakci B. Continuous Renal Replacement Therapy Applications on Extracorporeal Membrane Oxygenation Circuit. Indian Journal of Critical Care Medicine 2017; 21 (6): 355-358. https://doi: 10.4103/ijccm.IJCCM_128_17
16. Foti L, Villa G, Romagnoli S, Ricci Z. Acute Kidney Injury and Extracorporeal Membrane Oxygenation: Review on Multiple Organ Support Options. International Journal of Nephrology Renovascular Disease 2021; 14: 321-329. https://doi: 10.2147/ ijnrd.S292893
17. Lambert HJ, Sharma S, Matthews JNS. I-KID study protocol: evaluation of efficacy, outcomes and safety of a new infant haemodialysis and ultrafiltration machine in clinical use: a randomised clinical investigation using a cluster stepped- wedge design. BMJ Paediatr Open 2021; 5 (1): e001224. https:// doi: 10.1136/bmjpo-2021-001224
18. Coulthard MG, Crosier J, Griffiths C, Smith J, Drinnan M et al. Haemodialysing babies weighing <8 kg with the Newcastle infant dialysis and ultrafiltration system (Nidus): comparison with peritoneal and conventional haemodialysis. Pediatric Nephrology 2014; 29 (10): 1873-1881. https://doi: 10.1007/ s00467-014-2923-3
19. Deep A, Nagakawa S, Tissieres P. Non-transplant options in paediatric acute liver failure-what is new? Intensive Care Medicine 2022; 48 (1): 114-117. https://doi: 10.1007/s00134- 021-06576-y
20. Rico MP, Fernández Sarmiento J, Rojas Velasquez AM, González Chaparro LS, Gastelbondo Amaya R et al. Regional citrate anticoagulation for continuous renal replacement therapy in children. Pediatric Nephrology 2017; 32 (4): 703- 711. https://doi: 10.1007/s00467-016-3544-9
21. Soltysiak J, Warzywoda A, Kociński B, Ostalska-Nowicka D, Benedyk A et al. Citrate anticoagulation for continuous renal replacement therapy in small children. Pediatric Nephrology 2014; 29 (3): 469-475. https://doi: 10.1007/s00467-013-2690-6
22. Persic V, Vajdic Trampuz B, Medved B, Pavcnik M, Ponikvar R, Gubensek J. Regional citrate anticoagulation for continuous renal replacement therapy in newborns and infants: Focus on citrate accumulation. Artificial Organs 2020; 44 (5): 497-503. https://doi: 10.1111/aor.13619
23. Fernández SN, Santiago MJ, López-Herce J, García M, Del Castillo J et al. Citrate anticoagulation for CRRT in children: comparison with heparin. Biomed Research International 2014; 786301. https://doi: 10.1155/2014/786301
24. Ronco C, Garzotto F, Brendolan A, Zanella M, Bellettato M et al. Continuous renal replacement therapy in neonates and small infants: development and first-in-human use of a miniaturised machine (CARPEDIEM). Lancet 2014; 383 (9931): 1807-1813. https://doi: 10.1016/s0140-6736(14)60799-6
25. Aygun F, Aygun D, Erbek Alp F, Zubarıoglu T, Zeybek C, Cam H. The impact of continuous renal replacement therapy for metabolic disorders in infants. Pediatric Neonatology 2018; 59 (1): 85-90. https://doi: 10.1016/j.pedneo.2017.04.004
26. Hanudel M, Avasare S, Tsai E, Yadin O, Zaritsky J. A biphasic dialytic strategy for the treatment of neonatal hyperammonemia. Pediatric Nephrology 2014; 29 (2): 315-320. https:// doi: 10.1007/s00467-013-2638-x
27. Vaara ST, Bellomo R. Extra-Renal Indications for Continuous Renal Replacement Therapy. Contributions to Nephrology 2018; 194: 90-98. https://doi: 10.1159/000485605
28. Eminoğlu FT, Öncül Ü, Kahveci F, Okulu E, Kraja E et al. Characteristics of continuous venovenous hemodiafiltration in the acute treatment of inherited metabolic disorders. Pediatric Nephrology 2022; 37 (6): 1387-1397. https://doi: 10.1007/ s00467-021-05329-9
29. Saritas Nakip O, Yildiz Y, Tokatli A. Retrospective evaluation of 85 patients with urea cycle disorders: one center experience, three new mutations. Journal of Pediatric Endocrinology Metabolism 2020; 33 (6): 721-728. https://doi: 10.1515/jpem- 2019-0413
30. Hu Y, Peng XM, Xiao ZH. Application of continuous renal replacement therapy in the treatment of neonates with inherited metabolic diseases. Zhongguo Dang Dai Er Ke Za Zhi 2021; 23 (5): 488-493. https://doi: 10.7499/j.issn.1008-8830.2101073
31. Pedersen O, Jepsen SB, Toft P. Continuous renal replacement therapy for critically ill infants and children. Danish Medical Journal 2012; 59 (2): A4385.
32. Hayes LW, Oster RA, Tofil NM, Tolwani AJ. Outcomes of critically ill children requiring continuous renal replacement therapy. Journal of Critical Care 2009; 24 (3): 394-400. https:// doi: 10.1016/j.jcrc.2008.12.017
33. Santiago MJ, López-Herce J, Urbano J, Solana MJ, del Castillo J et al. Clinical course and mortality risk factors in critically ill children requiring continuous renal replacement therapy. Intensive Care Medine 2010; 36 (5): 843-849. https://doi: 10.1007/s00134-010-1858-9
34. Yetimakman AF, Kesici S, Tanyildiz M, Bayrakci US, Bayrakci B. A Report of 7-Year Experience on Pediatric Continuous Renal Replacement Therapy. Journal of Intensive Care Medicine 2019; 34 (11-12): 985-989. https://doi: 10.1177/0885066617724339
35. Symons JM, Chua AN, Somers MJ, Baum MA, Bunchman TE et al. Demographic characteristics of pediatric continuous renal replacement therapy: a report of the prospective pediatric continuous renal replacement therapy registry. Clinical Journal of the American Society of Nephrology 2007; 2 (4): 732-738. https://doi: 10.2215/cjn.03200906
36. Andersson A, Norberg Å, Broman LM, Mårtensson J, Fläring U. Fluid balance after continuous renal replacement therapy initiation and outcome in paediatric multiple organ failure. Acta Anaesthesiologica Scandinavica 2019; 63 (8): 1028-1036. https://doi: 10.1111/aas.13389
37. Bhaskar P, Dhar AV, Thompson M, Quigley R, Modem V. Early fluid accumulation in children with shock and ICU mortality: a matched case-control study. Intensive Care Medicine 2015; 41 (8): 1445-1453. https://doi: 10.1007/s00134-015-3851-9
38. Gorga SM, Sahay RD, Askenazi DJ, Bridges BC, Cooper DS et al. Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy: a multicenter retrospective cohort study. Pediatric Nephrology 2020; 35 (5): 871-882. https://doi: 10.1007/s00467-019-04468-4
39. Ricci Z, Goldstein SL. Pediatric Continuous Renal Replacement Therapy. Contributions to Nephrology 2016; 187: 121-130. https://doi: 10.1159/000442370
40. Santiago MJ, López-Herce J, Urbano J, Solana MJ, del Castillo J et al. Complications of continuous renal replacement therapy in critically ill children: a prospective observational evaluation study. Critical Care 2009; 13 (6): R184. https://doi: 10.1186/ cc8172
41. Fernández S, Santiago MJ, González R, Urbano J, López J et al. Hemodynamic impact of the connection to continuous renal replacement therapy in critically ill children. Pediatric Nephrology 2019; 34 (1): 163-168. https://doi: 10.1007/s00467- 018-4047-7
42. Jander A, Tkaczyk M, Pagowska-Klimek I, Pietrzykowski W, Moll J et al. Continuous veno-venous hemodiafiltration in children after cardiac surgery. European Journal of Cardio- Thoracic Surgery 2007; 31 (6): 1022-1028. https://doi: 10.1016/j. ejcts.2007.03.001

APA	Gün E, Gurbanov A, Sarıtaş Nakip Ö, Yontem A, DURAK A, botan e, Kahveci F, Özcan S, azapağası e, emeksiz s, uysal yazıcı m, Kesici S, Ozgur Horoz O, ERDEVE O, BAYRAKCI B, yildizdas d, KENDIRLI T (2023). Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg. , 791 - 802. 10.55730/1300-0144.5642
Chicago	Gün Emrah,Gurbanov Anar,Sarıtaş Nakip Özlem,Yontem Ahmet,DURAK Ayşen,botan edin,Kahveci Fevzi,Özcan Serhan,azapağası ebru,emeksiz serhat,uysal yazıcı mutlu,Kesici Selman,Ozgur Horoz Ozden,ERDEVE OMER,BAYRAKCI BENAN,yildizdas dincer,KENDIRLI TANIL Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg. (2023): 791 - 802. 10.55730/1300-0144.5642
MLA	Gün Emrah,Gurbanov Anar,Sarıtaş Nakip Özlem,Yontem Ahmet,DURAK Ayşen,botan edin,Kahveci Fevzi,Özcan Serhan,azapağası ebru,emeksiz serhat,uysal yazıcı mutlu,Kesici Selman,Ozgur Horoz Ozden,ERDEVE OMER,BAYRAKCI BENAN,yildizdas dincer,KENDIRLI TANIL Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg. , 2023, ss.791 - 802. 10.55730/1300-0144.5642
AMA	Gün E,Gurbanov A,Sarıtaş Nakip Ö,Yontem A,DURAK A,botan e,Kahveci F,Özcan S,azapağası e,emeksiz s,uysal yazıcı m,Kesici S,Ozgur Horoz O,ERDEVE O,BAYRAKCI B,yildizdas d,KENDIRLI T Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg. . 2023; 791 - 802. 10.55730/1300-0144.5642
Vancouver	Gün E,Gurbanov A,Sarıtaş Nakip Ö,Yontem A,DURAK A,botan e,Kahveci F,Özcan S,azapağası e,emeksiz s,uysal yazıcı m,Kesici S,Ozgur Horoz O,ERDEVE O,BAYRAKCI B,yildizdas d,KENDIRLI T Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg. . 2023; 791 - 802. 10.55730/1300-0144.5642
IEEE	Gün E,Gurbanov A,Sarıtaş Nakip Ö,Yontem A,DURAK A,botan e,Kahveci F,Özcan S,azapağası e,emeksiz s,uysal yazıcı m,Kesici S,Ozgur Horoz O,ERDEVE O,BAYRAKCI B,yildizdas d,KENDIRLI T "Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg." , ss.791 - 802, 2023. 10.55730/1300-0144.5642
ISNAD	Gün, Emrah vd. "Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg". (2023), 791-802. https://doi.org/10.55730/1300-0144.5642

APA	Gün E, Gurbanov A, Sarıtaş Nakip Ö, Yontem A, DURAK A, botan e, Kahveci F, Özcan S, azapağası e, emeksiz s, uysal yazıcı m, Kesici S, Ozgur Horoz O, ERDEVE O, BAYRAKCI B, yildizdas d, KENDIRLI T (2023). Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg. Turkish Journal of Medical Sciences, 53(3), 791 - 802. 10.55730/1300-0144.5642
Chicago	Gün Emrah,Gurbanov Anar,Sarıtaş Nakip Özlem,Yontem Ahmet,DURAK Ayşen,botan edin,Kahveci Fevzi,Özcan Serhan,azapağası ebru,emeksiz serhat,uysal yazıcı mutlu,Kesici Selman,Ozgur Horoz Ozden,ERDEVE OMER,BAYRAKCI BENAN,yildizdas dincer,KENDIRLI TANIL Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg. Turkish Journal of Medical Sciences 53, no.3 (2023): 791 - 802. 10.55730/1300-0144.5642
MLA	Gün Emrah,Gurbanov Anar,Sarıtaş Nakip Özlem,Yontem Ahmet,DURAK Ayşen,botan edin,Kahveci Fevzi,Özcan Serhan,azapağası ebru,emeksiz serhat,uysal yazıcı mutlu,Kesici Selman,Ozgur Horoz Ozden,ERDEVE OMER,BAYRAKCI BENAN,yildizdas dincer,KENDIRLI TANIL Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg. Turkish Journal of Medical Sciences, vol.53, no.3, 2023, ss.791 - 802. 10.55730/1300-0144.5642
AMA	Gün E,Gurbanov A,Sarıtaş Nakip Ö,Yontem A,DURAK A,botan e,Kahveci F,Özcan S,azapağası e,emeksiz s,uysal yazıcı m,Kesici S,Ozgur Horoz O,ERDEVE O,BAYRAKCI B,yildizdas d,KENDIRLI T Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg. Turkish Journal of Medical Sciences. 2023; 53(3): 791 - 802. 10.55730/1300-0144.5642
Vancouver	Gün E,Gurbanov A,Sarıtaş Nakip Ö,Yontem A,DURAK A,botan e,Kahveci F,Özcan S,azapağası e,emeksiz s,uysal yazıcı m,Kesici S,Ozgur Horoz O,ERDEVE O,BAYRAKCI B,yildizdas d,KENDIRLI T Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg. Turkish Journal of Medical Sciences. 2023; 53(3): 791 - 802. 10.55730/1300-0144.5642
IEEE	Gün E,Gurbanov A,Sarıtaş Nakip Ö,Yontem A,DURAK A,botan e,Kahveci F,Özcan S,azapağası e,emeksiz s,uysal yazıcı m,Kesici S,Ozgur Horoz O,ERDEVE O,BAYRAKCI B,yildizdas d,KENDIRLI T "Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg." Turkish Journal of Medical Sciences, 53, ss.791 - 802, 2023. 10.55730/1300-0144.5642
ISNAD	Gün, Emrah vd. "Clinical characteristics and outcomes of continuous renal replacement therapy performed on younger children weighing up to 10 kg". Turkish Journal of Medical Sciences 53/3 (2023), 791-802. https://doi.org/10.55730/1300-0144.5642